Provider Demographics
NPI:1750811394
Name:COWELL, RYAN (MS, LAC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:COWELL
Suffix:
Gender:M
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 W WORCHESTER
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-8973
Mailing Address - Country:US
Mailing Address - Phone:831-801-8935
Mailing Address - Fax:
Practice Address - Street 1:515 ENTERPRISE DR STE 300
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:AR
Practice Address - Zip Code:72745-8982
Practice Address - Country:US
Practice Address - Phone:479-717-7626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-15
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1706223101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor